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Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea

• CME Information
• Faculty Biographies & Disclosures
• References
• Course Presentations
• CME Posttest

CME Information

Course Overview Educational Objectives Target Audience Method of Participation

Accreditation Statement Term of Approval Peer Review Program Director

Disclaimer Disclosure Acknowledgement of Support

Course Overview

Obstructive sleep apnea (OSA) is an important public health issue due to associated morbidity and mortality rates, attendant comorbidities (e.g., hypertension and diabetes), and adverse effects on quality of life. Attended in-laboratory polysomnography (PSG) is the current diagnostic standard for OSA. Portable sleep monitors (types II, III, and IV) can also record neurophysiologic and cardiorespiratory signals predictive of OSA, and various patient questionnaires are available for initial patient screening. The most common form of treatment for OSA is continuous positive airway pressure (CPAP). Other interventions include oral devices, surgical treatments, weight loss programs, positional therapy and complementary and alternative medicine. Patient compliance presents significant barriers to successful treatment.

This CME activity covers data from a systematic review of existing research that was conducted by the Tufts Evidence-based Practice Center to evaluate the level of evidence currently available regarding the diagnosis and treatment of OSA. It reviews evidence on diagnostic and screening tools for OSA and provides an overview of the comparative benefits and harms of interventions for OSA, as well as factors that influence patient compliance with treatment.

Educational Objectives

At the conclusion of this activity, the participant should be able to:

• Identify available tests for diagnosing obstructive sleep apnea.
• Order and/or perform those diagnostic tests associated with the strongest evidence of effectiveness in suspected cases of obstructive sleep apnea.
• Describe what is known about the relationship between apnea-hypopnea index and long-term clinical and functional outcomes.
• Incorporate those treatment methods associated with the strongest evidence of effectiveness in managing obstructive sleep apnea.
• Describe the strengths, limitations and knowledge gaps of the current evidence about benefits and harms for each therapeutic intervention.

Target Audience

This CME activity is designed to meet the educational needs of primary care physicians and other healthcare providers who treat patients with obstructive sleep apnea.

Method of Participation

This activity is in PowerPoint file format and is accompanied by talking points and references linked to PubMed abstracts.

To receive a maximum of 1.0 AMA PRA Category 1 Credit(s)™ you should:

• View the presentations in this enduring material.
• Complete the posttest (you must answer 8 out of 10 questions correctly).
• Complete and submit the CME registration and evaluation forms.

The estimated time to complete this activity, including review of the materials, is 1.0 hour(s).

Hardware/software requirements: Activities should be run with recent versions of common browsers, including Internet Explorer, Firefox, and Google Chrome.

If you have questions about the participation process, please e-mail the Office of Continuing Medical Education, cme@bcm.edu or phone 713.798.8237.

Accreditation/Credit Designation

Baylor College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Baylor College of Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.    

Term of Approval

August 2011 through August 2014. Original release date: August 2011

Peer Review

In July 2011,  this continuing medical education online enduring material was reviewed by Charles W. Atwood, Jr, MD, Associate Professor of Medicine, Sleep Medicine Fellowship Director, University of Pittsburgh and Director, Sleep Disorders Program, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. To ensure the continued scientific relevance of this enduring material, its content will be reviewed again in July 2014.

Disclosures: Advisory Committee Member – Care Core National, Inc.;  Consultant – Philips-Respironics, Resmed, Embla; Board Member – Board of Registered Polysomnographic Technologists.

Program Director

Michael Fordis, MD
Sr. Associate Dean
Director, Center for Collaborative and Interactive Technologies
Director, John M. Eisenberg Center for Clinical Decisions and Communications Science
Baylor College of Medicine
Houston, Texas

Disclosures: Nothing to disclose.

Disclaimer

This CME activity is designed for use by healthcare professionals for educational purposes only. Information and opinion offered by the contributors represent their viewpoints. Conclusions drawn by the participant should be derived from careful consideration of all available scientific information. Prescription information and use of medical devices should be undertaken only after confirmation of information by consulting the FDA-approved uses and information.

Baylor College of Medicine makes every effort to have accurate information presented, no warranty, expressed or implied, is offered. The participant should use his/her clinical judgment, knowledge, experience, and diagnostic decision-making before applying any information, whether provided here or by others, for any professional use.

Links are provided to other Internet sites solely for the convenience of users. Once you link to another site, you are subject to the site's terms and conditions of use including copyright and licensing restrictions.

Disclosure

The Office of Continuing Medical Education (OCME) makes every effort to develop CME activities that are scientifically based, accurate, current, and objectively presented. In accordance with the Accreditation Council for Continuing Medical Education Standards for Commercial Support ^SM, Baylor College of Medicine (BCM) has implemented a mechanism requiring everyone in a position to control the content of an educational activity (e.g., directors, planning committee members, contributors, peer reviewers) to disclose any relevant financial relationships with commercial interests (drug/device companies) and manage/resolve any conflicts of interest prior to the activity. Individuals must disclose to participants the existence or non-existence of financial relationships: l) at the time of the activity or within 12 months prior; and 2) of their spouses/partners.

Baylor College of Medicine does not view the existence of interests or relationships with commercial entities as implying bias or decreasing the value of a presentation. It is up to the participants to determine whether the interests or relationships influence the presenter with regard to exposition or conclusions.

If at any time during this activity you feel that there has been commercial or promotional bias, please inform us by using the commercial bias comments box in the evaluation form. Please answer the questions about balance in the CME activity evaluation candidly.

The following individual(s) has/have reported no financial or other relationships with commercial entities whose products/services may relate to the educational content of this activity:

Ethan M. Balk, MD, MPH, Contributor: nothing to disclose
Michael Fordis, MD, Activity Director: nothing to disclose
Amir Sharafkhaneh, MD, PhD, DABSM, Contributor: nothing to disclose
Emily Roberge White, Medical Writer: nothing to disclose

Some drugs/devices identified during this activity may have United States Food and Drug Administration (FDA) clearance for specific purposes only or for use in restricted research settings. The FDA has stated that it is the responsibility of the individual physician to determine the FDA status of each drug or device that he/she wishes to use in clinical practice and to use the products in compliance with the applicable law.

Baylor College of Medicine requires that all contributors disclose an unlabeled use or investigational use (not yet approved for any purpose) of pharmaceutical and medical device products, and provide adequate scientific and clinical justification for such use. Physicians are urged to fully review all the available data on products or procedures before using them to treat patients.

Acknowledgement of Support

This CME activity is supported by a contract, HHSA290200810015C, from the Agency for Healthcare Research and Quality.

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